Data collected from three U.S. population-based birth defects surveillance systems from 2013 and 2014, before the introduction of Zika virus infection in the World Health Organization’s Region of the Americas, showed a baseline prevalence of birth defects potentially related to congenital Zika virus infection of 2.9 per 1,000 live births. Based on 2016 data from the U.S. Zika Pregnancy and Infant Registry, the risk for birth defects potentially related to Zika virus infection in pregnancies with laboratory evidence of possible Zika virus infection was approximately 20-fold higher than the baseline prevalence.

What is added by this report?

This report provides the first comprehensive data on the prevalence of birth defects (3.0 per 1,000 live births) potentially related to Zika virus infection in a birth cohort of nearly 1 million births in 2016. A significant increase in birth defects strongly related to Zika virus during the second half of 2016 compared with the first half was observed in jurisdictions with local Zika virus transmission. Only a small percentage of birth defects potentially related to Zika had laboratory evidence of Zika virus infection, and most were not tested for Zika virus.

What are the implications for public health practice?

Whereas the U.S. Zika Pregnancy and Infant Registry monitors women with laboratory evidence of possible Zika virus infection during pregnancy and their congenitally exposed infants, population-based birth defects surveillance systems make a unique contribution by identifying and monitoring all cases of these birth defects regardless of exposure or laboratory testing or results.

Continued surveillance for birth defects potentially related to Zika virus infection is important because most pregnancies affected by Zika virus ended in 2017. These data will help communities plan for needed resources to care for affected patients and families and can serve as a foundation for linking and evaluating health and developmental outcomes of affected children.

Advocates for Canadian seniors are calling on provincial governments to cover the cost of a new vaccine to protect against shingles, a brutally painful illness that can have debilitating consequences.

Shingrix was approved by Health Canada last year and its manufacturer, GlaxoSmithKline, says it should be available in local pharmacies that order it by mid-January.

An existing vaccine is available against shingles — Zostavax — but it's not reported to be as effective in preventing it, especially among older people.

"When we look at the impact on people's lives, shingles can be so devastating," said Wanda Morris, vice-president of advocacy at CARP, formerly known as the Canadian Association of Retired Persons. "This is something we really need government to look at."

CARP advocated for Zostavax to be covered, but so far Ontario is the only province that picks up the tab for it and only for those aged 65 to 70. Now the advocacy organization is pushing for Shingrix to be paid for by provincial health plans. It costs about $244 [US$194], plus any pharmacy dispensing fees.

Morris said the cost is worth it, given the financial burden shingles can have on individuals, their families, and the health care system, in addition to the physical pain people suffer. Those who get shingles might miss work, and can have trouble carrying out daily functions and caring for their loved ones, including spouses or children. Doctor visits or hospitalization are a cost to the health system.

"There is a strong, solid business case, but you never want to see people in that much pain and we don't want to put the strains on caregivers and businesses and others who will be impacted," said Morris.

130,000 people get shingles annually

An estimated 130,000 Canadians get shingles every year and the older you are, the more likely you are to get it and to suffer severe health effects.

The new vaccine to help prevent it is being touted by doctors as a breakthrough in the battle to protect seniors from preventable illnesses. Shingrix is recommended for people 50 and older. It is taken in two doses, a few months apart.

"It is definitely the first vaccine that looks like it is very effective in older adults and that's impressive," Dr. Allison McGeer, a microbiologist at Mount Sinai Hospital in Toronto, said.

Vaccines generally don't work that well in older Canadians and that's why the clinical trial results for Shingrix are so remarkable, said McGeer.

The trials showed efficacy against shingles above 90 per cent, regardless of the person's age.

Shingles is a brutally painful infection that anyone who has had chickenpox is at risk of getting. It is caused by the same virus as chickenpox, which can lie dormant for years and then reactivate in the form of shingles.

My wife and I have both had Zostavax, and paid for it; nonetheless, my wife developed shingles about a year ago, and it was an intensely unpleasant experience. She still feels pain, months after the rash vanished. I gather that she could suffer a recurrence, though it's unlikely, but I certainly intend to get the new vaccine—and she may too.

And yes, the vaccine should be free, just as flu vaccine is for seniors in Canada.

The plight of children suffering from nodding syndrome in some districts of northern Uganda remains precarious, and efforts to give them proper care seems to be waning.

On Friday, this newspaper reported that five children with nodding syndrome had drowned in Omoro District on separate occasions. According to area leaders, the children, aged between 14 and 15 years, were said to have died in January and June in different villages in Odek Sub-county after developing seizures at water points.

The deceased children, according to Odek Sub-county chairperson Richard Labongo Okello, are some of those who had been reintegrated into the communities after undergoing rehabilitation at the Odek nodding syndrome care centre. Some of the children, however, relapsed due to poor living conditions in the communities.

The bigger dilemma for the communities where nodding syndrome is still rampant is what the future holds for the children suffering from this mysterious condition.

Last week, we reported that Omoro District leaders had asked government to take over the Nodding Syndrome Care Facility in Odek Sub-county.

The centre had, since 2012, been supported by Hope for Humans, a non-governmental organisation, which was providing medical and personal care, special schooling, and nutritious meals to children with nodding syndrome. In July, the organisation’s chief executive officer, Ms Suzanne Gazda, said the board of directors had made a ‘difficult decision’ to dissolve Hope for Humans and transition the children into the care of Ugandan government.

Ideally, this centre should still be taking care of children, including carrying out community outreach programmes in homes of those recovering from nodding syndrome. But due to lack of funds, the 29 children still living at the centre and another 237 who were rehabilitated and reintegrated in their communities, are not receiving the care they need to prevent possible relapse.

Although Ms Grace Kwiyocwiny, the State Minister for Northern Uganda, recently visited the centre and said the government would partner with the district and other stakeholders to ensure the centre is supported, such assurances should be followed with immediate action. These children have suffered for far too long. Their parents, guardians and entire communities have been condemned to a life of misery since nodding syndrome was first discovered in the area.

For communities that have suffered a two-decade war under Joseph Kony’s Lords Resistance Army, nodding disease is like another war, a war on their children, their future. Lest we forget, nodding syndrome is still rampant in northern Uganda. The affected children deserve proper care.

December 14, 2017

Two years ago at this time, heart-stopping pictures of infants with shrunken heads began appear in the news. The world met the Zika babies of Brazil.

But what has happened to those children whose life trajectories were altered when Zika-infected mosquitoes bit their pregnant mothers? A new report paints a bleak picture, one that suggests Brazilian children who were born with severe microcephaly and whose blood showed signs of prior Zika infection are at increased risk of cerebral palsy, seizures, vision problems, and many other conditions.

Those findings — published Thursday in Morbidity and Mortality Weekly Report, a journal published by the Centers for Disease Control and Prevention — come from a small study of the health status of 19 babies born with Zika-related microcephaly.

The children, who ranged from 19 months to 2 years of age when the assessments were done, were all born between Oct. 1, 2015, and Jan. 31, 2016.

The assessments involved interviews with their caregivers, clinical evaluations, and reviews of their medical histories. The infants were given a standardized neurological exam aimed at seeing if they are developing at the same rate as healthy children, called the Ages and Stages Questionnaires.

Fifteen of the 19 children had not met the developmental milestones — like being able to sit up by themselves — that a healthy 6-month-old would meet, the authors reported.

“They’re profoundly affected, in both their health and their development,” said Dr. Cynthia Moore, chief medical officer in CDC’s division of congenital and developmental disorders.

And Moore admitted they are not likely to grow out of their problems.

“Any babies that have this degree of microcephaly, we would not expect them to catch up,” she said. “We can’t make predictions about exactly what’s going to be their status as they go through childhood into adulthood. But we believe they’ll have lifelong challenges.”

December 13, 2017

A new study sheds light on how the mosquito-borne Zika virus causes a rare neurological condition, and the findings could have implications for companies working on Zika vaccines, U.S. researchers said on Wednesday.

The Zika outbreak that swept through the Americas in 2015 and 2016 showed the virus could, in rare cases, cause Guillain-Barre, an autoimmune disorder in which the body attacks itself in the aftermath of an infection.

Since the Zika virus attacks nerve cells, scientists were not sure whether the Guillain-Barre cases they had seen in Zika patients were caused by an autoimmune response to the Zika infection or a direct attack by the virus on nerve cells.

In pregnant women, the virus infects fetal brain cells, resulting in the birth defect known as microcephaly.

To study the nerve disorder, Dr. Tyler Sharp of the U.S. Centers for Disease Control and Prevention’s Dengue Branch in San Juan and colleagues in Puerto Rico examined the rare case of a 78-year-old man from San Juan who had been infected with Zika in 2016, developed Guillain-Barre and subsequently died.

An autopsy showed inflammation and erosion of the protective sheath known as myelin in two nerves, but no evidence of the Zika virus in nerve cells.

“In this case, it looks like it was antibodies that led to destruction of that myelin sheath,” said Sharp, whose study was published in Emerging Infectious Diseases, the CDC’s public health journal.

Although it was just a single case, Sharp said it suggested the mechanism that causes Guillain-Barre after a Zika infection was the same as in other cases of the nerve disorder.

Sharp said the study raised a caution flag, however, for companies testing experimental Zika vaccines. Although Guillain-Barre typically occurs in the aftermath of an infection, it has been known to occur in response to a vaccine.

“Vaccine manufacturers do need to be thinking about Guillain-Barre as a potential outcome of vaccination against Zika,” he said.

AGUA CALIENTE, Mexico, Dec 4 (Thomson Reuters Foundation) - Eduardo Baltazar is the youngest person in the tiny Mexican village of Agua Caliente to have a kidney transplant, undergoing the life-saving surgery a month shy of his 13th birthday.

The boy is one of many victims of a health crisis in the western state of Jalisco that environmental experts are linking to water and air pollution, despite denials by the government.

A University of Guadalajara investigation into the 950 residents of Agua Caliente on the shores of Lake Chapala has confirmed what locals have known for years - chronic kidney disease has reached epidemic levels and is hitting children hardest.

From the smog-coated capital to polluted lakeside villages, agricultural and industrial pollution and poor regulation have sickened communities across Mexico, say campaigners.

Before his transplant in June, Baltazar suffered terrible pain and plugged himself into a home dialysis machine four times a day, a treatment paid for by charity and health insurance.

With his diminutive frame, the boy looks much younger than his age. When the disease caused his cheeks to bulge with fluids, his classmates taunted him and he stopped going to school.

"I saw him in great suffering and I just thought, 'That's enough,'" said his aunt, Brenda Baltazar, who donated her kidney to her nephew.

The university researchers say toxic contaminants caused by agricultural pesticides that flow into Mexico's largest freshwater lake have compounded the miseries of Agua Caliente residents already battling malnutrition and poverty.

But the state government blames a range of other factors for the epidemic of sickness - from diet to pollution from cooking with firewood and even inbreeding.

DAMAGED KIDNEYS, MEMORY DEFICITS

More than half of schoolchildren in the village have damaged kidneys, and only one in six demonstrates healthy cognitive development, university investigators say.

The research has found significant attention and memory deficits among local children, according to leading investigator Aarón Peregrina. Many also struggle with fine motor skills, used for drawing, writing and eating.

"The preschool teacher tells the children not to draw beyond the lines when they color an image," Peregrina told the Thomson Reuters Foundation.

"But many children simply can't perform these movements."

Guadalajara's Civilian Hospital documented 70 cases of birth defects from 2009 to 2016 in Poncitlán municipality, which includes Agua Caliente and a handful of other villages on the shores of Lake Chapala.

The abnormalities include heart defects, club feet and malformed hands, according to the Guadalajara Socio-Environmental Forum, an activist group.

The Baltazar family has been devastated. Eduardo's 17-year-old cousin, who grew up in the same cinder-block home, is battling end-stage renal disease. His sister Estrella died from kidney failure at age 10 last year.

During 2015 to 2016, Brazil reported more Zika virus (ZIKV) cases than any other country, yet population exposure remains unknown. Serological studies of ZIKV are hampered by cross-reactive immune responses against heterologous viruses.

Sera sampled retrospectively during 2013 to 2015 from 277 HIV-infected patients were used to assess the spread of ZIKV over time. Individuals were georeferenced, and sociodemographic indicators were compared between ZIKV-positive and -negative areas and areas with and without microcephaly cases. Epidemiological key parameters were modeled in a Bayesian framework.

High seroprevalence, combined with case data dynamics allowed estimates of the basic reproduction number R0 of 2.1 (CI, 1.8 to 2.5) at the onset of the outbreak and an effective reproductive number Reff of <1 in subsequent years.

Our data corroborate ZIKV-associated congenital disease and an association of low SES and ZIKV infection and suggest that population immunity caused cessation of the outbreak. Similar studies from other areas will be required to determine the fate of the American ZIKV outbreak.

The Zika virus crisis exemplified the risk associated with emerging pathogens and was a reminder that preparedness for the worst-case scenario, although challenging, is needed. Herein, we review all data reported during the unexpected emergence of Zika virus in French Polynesia in late 2013.

We focus on the new findings reported during this outbreak, especially the first description of severe neurological complications in adults and the retrospective description of CNS malformations in neonates, the isolation of Zika virus in semen, the potential for blood-transfusion transmission, mother-to-child transmission, and the development of new diagnostic assays.

We describe the effect of this outbreak on health systems, the implementation of vector-borne control strategies, and the line of communication used to alert the international community of the new risk associated with Zika virus.

This outbreak highlighted the need for careful monitoring of all unexpected events that occur during an emergence, to implement surveillance and research programmes in parallel to management of cases, and to be prepared for the worst-case scenario.

November 12, 2017

Medical researchers and government health policymakers, a cautious lot, normally take pains to keep expectations modest when they’re discussing some new finding or treatment.

They warn about studies’ limitations. They point out what isn’t known. They emphasize that correlation doesn’t mean causation.

So it’s startling to hear prominent experts sound positively excited about a new shingles vaccine that an advisory committee to the Centers for Disease Control and Prevention approved last month.

“This really is a sea change,” said Dr. Rafael Harpaz, a veteran shingles researcher at the C.D.C.

Dr. William Schaffner, preventive disease specialist at the Vanderbilt University School of Medicine, said, “This vaccine has spectacular initial protection rates in every age group. The immune system of a 70- or 80-year-old responds as if the person were only 25 or 30.”

“This really looks to be a breakthrough in vaccinating older adults,” agreed Dr. Jeffrey Cohen, a physician and researcher at the National Institutes of Health.

What’s causing the enthusiasm: Shingrix, which the pharmaceutical firm GlaxoSmithKline intends to begin shipping this month. Large international trials have shown that the vaccine prevents more than 90 percent of shingles cases, even at older ages.

The currently available shingles vaccine, called Zostavax, only prevents about half of shingles cases in those over age 60 and has demonstrated far less effectiveness among elderly patients.

Yet those are the people most at risk for this blistering disease, with its often intense pain, its threat to vision and the associated nerve pain that sometimes last months, even years, after the initial rash fades.

Almost all older Americans harbor the varicella zoster virus that causes shingles; they acquired it with childhood chickenpox, whether they knew they had the disease or not.

The virus stays dormant until, for unknown reasons, it erupts decades later. The risk rises sharply after age 50. Shingles is hardly a minor menace.

“A million cases occur in the United States each and every year,” Dr. Schaffner said. “If you’re fortunate enough to reach your 80th birthday, you stand a one-in-three to one-in-two chance of shingles.”

My wife and I have both had the old vaccine. But a year ago she came down with shingles anyway. It was a wretched, painful condition that lasted for months; she still feels some pain. We will assuredly get the new vaccine as soon as it's available here.

About 14 million Myanmar children, aged from nine months to 15 years old, will soon to be vaccinated against Japanese encephalitis across the nation starting from Nov. 15, official Global New Light of Myanmar reported Sunday.

Under the management of the Ministry of Health and Sports, the vaccination programs will be conducted into two different themes, school-based vaccination program which will be conducted from Nov. 15 to Nov. 23 and people-based vaccination program from Dec. 11 to Dec. 18, respectively.

The school-based vaccination program will be conducted in designated local and international schools at different education levels as well as monastic education.

Meanwhile, the people-based vaccination program will be conducted in hospitals, regional health centers and designated private homes.

The authorities are also exerting efforts to reach every child in the country with vaccines under the program, especially in difficult-to-reach villages and border areas.

Japanese Encephalitis virus is maintained in a cycle involving mosquitoes and vertebrate hosts, mainly pigs and wading birds. Humans can be infected when bitten by an infected mosquito.

Some infected patients will develop neurological symptoms including tremors, seizures (especially among children), as well as mental status changes and movement disorders.

Japanese Encephalitis can be fatal in 20 to 30 per cent of cases and most of survivors continue to have neurologic, cognitive or psychiatric symptoms.